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Running head: Milestone Three – Morphine and Hospice1Milestone Three – Family Education on Morphine with Hospice CareAmy MunroeSouthern New Hampshire UniversityNUR-440June 1, 2018
Morphine and Hospice2IntroductionIn 2014, more than 1.6 million Americans received hospice services (Chi, Demiris, Pike, Washington, & Oliver, 2017). Hospice consists of an interdisciplinary team of nurses, doctors, chaplaincy and social work. The goal of hospice is comfort care and the end of life. It includes pain control, symptom management and spiritual needs (Chi, Demiris, Pike, Washington, & Oliver, 2017). Despite the goal of pain management, studies find that many hospice patients are not having their pain managed at a level that provides an ideal quality of life during their final days (Mayahara, Foreman, Wilbur, Paice, & Fogg, 2015). Many barriers exist that contribute to the undertreatment of pain during the end of life. Misconceptions about pain management include family concerns about addiction and the belief that opioids, such as morphine, can impede death (Cagle et al., 2015). Cagle, et. al, 2015., also found that a lack of family education regarding pain management, fears and stigmas further prevented effective pain management.PICO(T) QuestionPain management is of vital importance to improve the quality of life for hospice patients. Therefore, it is the purpose of this paper to formulate a PICO(T) question to evaluate evidence to improve pain management for hospice patients. In adult patients with a terminal illness, does family education about morphine use during initial hospice admission compared with education during transition to active dying, improve pain management, quality of life and family anxiety during the last three months of life?
Morphine and Hospice3Annotated BibliographyCagle, J. G., Zimmerman, S., Cohen, L. W., Porter, L. S., Hanson, L. C., & Reed, D. (2015). EMPOWER: An intervention to address barriers to pain management in hospice. Journal of Pain and Symptom Management,49(1), 1-12. doi:10.1016/j.jpainsymman.2014.05.007The authors of this study tested the efficacy of the Effective Management of Pain: Overcoming Worries to Enable Relief (EMPOWER) intervention. The aim of the study focused on addressing patients and family caregivers concerns about pain medication as a barrier to pain management on admission to hospice. EMPOWER includes staff education, screening of barriers at admission, and discussions with patients and families regarding misconceptions of pain management. The study was a pilot, cluster randomized, controlled trial that included four hospices. A total of One hundred twenty-six family members were interviewed two weeks after admission and again three months after admission if the patient were still living. There were fifty-five cases in the intervention group and seventy-one cases in the control group.